Provider Demographics
NPI:1780737197
Name:RILEY, GRACE MERCHANT (ARNP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MERCHANT
Last Name:RILEY
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:MERCHANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-223-3898
Mailing Address - Fax:689-223-3898
Practice Address - Street 1:2255 DUNN AVE STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4739
Practice Address - Country:US
Practice Address - Phone:904-861-1900
Practice Address - Fax:904-292-9264
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR106911363LF0000X
FLARNP9281007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily